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Understanding Male Infertility Infertility effects one in every six couples, about 10% of all men in the United States who are attempting to conceive suffers from infertility.<br />Historically, infertility has been considered a women's disease. It is only within the last fifty years that the importance of the male factor contribution to infertility has been recognized.<br />The most common identifiable cause of infertility in men is varicocele. This is a condition of enlarged veins in the scrotum that causes abnormalities in the temperature regulation of the testis. Enzymes that are responsible for both sperm and hormone (testosterone) production have an optimal temperature at which they operate most effectively. If this temperature is elevated by even one degree, sperm and testosterone production are adversely affected.<br />The average healthy sperm count after repair of the large varicoceles has been shown to increase 128%. Sponsored by the World Health Organization (WHO) and reported in Fertility and Sterility. The results showed the pregnancy rate in couples where men with varicoceles underwent surgery was three times higher than when men did not undergo surgery.<br />The second major cause of infertility in men is blockages or obstructions of the male reproductive tract, a condition called">1. men who have an obstruction problem or blockage, meaning they are making sperm, but the sperm can't get out, or 2. men who have a production problem, meaning they are not making sperm, a condition called "non-obstructive " azoospermia." We can easily determine which group an infertile male is in by doing a testicular biopsy, also using a microscope to minimize discomfort and complications. Blockage can also be caused by a urinary tract infection or by the sexually transmitted diseases chlamydia and gonorrhea. Bacteria can infect the tiny duct called the "epididymis," which is essentially a swimming school for sperm before they are able to swim to fertilize an egg. Infection of the epididymis can cause scarring and blockage, inhibiting the sperm from leaving the duct to fertilize an egg. One of the most common causes of blockage is vasectomy. Approximately 500,000 to a million men undergo vasectomy each year. Artificial techniques of reproduction have advanced to the point where a single sperm can be physically injected into an egg. This procedure, called intracytoplasmic sperm injection (ICSI), was developed in Belgium by Gianpiero Palermo, a physician/scientist who now works with us at The New York-Cornell Hospital. ICSI has dramatically changed the treatment available for even the most severe male factor infertility. Because of this technique, 90% of all infertile men, including half of all men with non-obstructive azoospermia, have the potential to conceive their own genetic child. By Marc Goldstein, M.D., FACS
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